How to Choose a Nursing Home

Updated on December 28, 2008

Unfortunately many of us at some point in our lives will have to face the discouraging prospect of whether or not to place one of our loved ones within the care of a nursing home. This can be an emotionally and physically draining experience for those individuals who are determined to ensure appropriate and loving care. The best way to begin down this path is to know what the very minimum levels of care are as you examine the multitude of options before you. To find these standards, you should check with your state's Department of Health Services' District Office and ask to see the latest list of nursing homes in your area. This document should list all the facilities by county and that are licensed by the State and whether or not they are currently in compliance with the law.

When you have narrowed your list of choices, it is also wise to physically visit each home to gain a sense of how they operate and the atmosphere within the facility. Ask to see the State Department of Health Services' most recent survey (inspection) results of the home you are visiting to view their ratings on patient-nurse ratios, doctor-patient ratios, and any complaints that have been filed against them. Every nursing home is required to post a copy in a readily accessible place or post where it can be obtained.

The pure and simple truth of the matter is that understaffing leads to poor care. To give you a realistic perspective, California nursing homes restrain residents at twice the national rate (instead of hiring more staff to deal with patients they restrain them) and have higher levels of bedsores. On February 5, 2008, the U.S. Centers for Medicare and Medicaid Services (CMS) named 674 California nursing facilities that had troubling levels of restrained residents and/or residents with pressure sores. Hence, try and locate a home that has a high patient-nurse ratio; Congress has recommended 4.1 hours of care per resident per day. Use this figure as a guideline. Abuse and neglect of residents by nursing staff is higher where they are working in stressful conditions. Better staffing is associated with lower worker injury rates and reduced litigation.

It has been my experience that if you can describe the general atmosphere of a facility as "comatose" - chances are high that the home utilizes drugs at a higher rate than most. Patients need not sit abandoned in hallways, looking listlessly into space. They need not cry out at unseen objects, or fear the presence of strangers if time and attention are taken to relieve a resident's fears. But the facts remain that the use of drugs in homes across America are increasing. According to the Wall Street Journal, nearly 21% of nursing home residents are receiving antipsychotic drugs "off-label." That means that nursing home residents who are not diagnosed as psychotic can receive these drugs for dementia, a condition prevalent among many elderly nursing home residents. This is disturbing and alarming on several levels. To ensure the safety of your loved one, always inquire at the facility to know whether or not they require you to sign off on any drug prescribed.

Finally, ask to see if the facility is a non-profit or for-profit home. Traditionally, those that are non-profits are operated with higher staffing ratios, consistent care, and fewer complaints. While lists concerning the licensure status and complaint status of homes within your state are inconsistent and rare at best, always check whether or not your state Department of Health has an online consumer database for individuals seeking information on where to place their loved one.

Remember: arm yourself with knowledge before you make a choice.

Comments 4 comments

Good article, Stephanie! Another thing to check is the mobility of the residents. Too many in wheelchairs as opposed to using canes and walkers could mean that the administration is more afraid of lawsuits if patients fall. It's also easier for them to control someone in a wheelchair!

Keep writing!

ChaiRachelRuth 7 years ago

My Dad was admitted to a nursing home several months ago. Unfortunately, I didn't choose the facility. It's very sad as he's not getting the stimulation he would have gotten at home, but my step-Mom could no longer handle the situation.

I used to do pet therapy with my dog several years ago. We quickly weeded out which facilities we visitied based on how well the home staffed our visit with our dogs. If they saw us as an excuse to leave us alone with residents, we never went back, if the event was staffed and facilitated by an activities person who made sure the residents that attended liked dogs, we went back. It says a lot that the group only visits one nursing home in the area.

You wrote an important hub.

\Brenda Scully 7 years ago

Hi enjoyed this hub...... I also have written a hub on nursing homes not quite as detailed,.

After working in one most of my adult life, I would certainly take your wise words on board......

GoGranny 7 years ago from Southeastern PA

This hub has many good points. I have worked in nursing homes for the past 30 years. I just want to say that I agree that staffing is the key to quality nursing home care, along with a knowledgeable and caring administration. The problem is largely financial. The government sets the minimal staffing requirements and determines how much it SHOULD cost to care for a resident depending on the amount of care needed. Believe me that the formulas used do not do provide enough to do everything that one would like to do for all of the residents. I can attest that all of the homes that I have worked in do the best they can with what they are given to work with. The government now has the nerve to be considering cuts to Medicare & Medicaid. The end result of that will be forced cutbacks at homes and staffing is often hit first. Then the care suffers, not because the staff don't work, it's because cuts leave them with too much work to give ALL residents ALL they should have. The problem is a universal 'catch 22'.